Issue 1 – Standard of dentures provided
21. Mrs K complains on 31 July 2023 the Practice provided her with a temporary upper denture which was ill fitted and cosmetically different in length to her original teeth. Mrs K says the temporary denture was not fit for purpose as she struggled to eat with it. She also says it was not a good cosmetic match and caused her embarrassment affecting her confidence.
22. Mrs K raised her concerns with her associate dentist during the appointment and subsequent complaint on 29 September 2023.
23. We first considered whether Mrs K’s temporary denture met the required standard. Guidelines in Prosthetic Dentistry says ‘partial dentures should assist the mastication of food (chewing), be cosmetically pleasing, and help maintain normal speech. They may also be required to maintain oral health and prevent tilting and overeruption (moving out of position) of natural teeth’.
24. Our dental adviser reviewed Mrs K’s dental records and photographs of her temporary denture. Our dental adviser told us the upper temporary denture did not restore function, or appearance, of Mrs K’s extracted teeth. In particular, our dental adviser noted the temporary denture did not meet her bottom teeth, so a chewing function was not restored. They noted the temporary denture was also shorter in appearance than the rest of the teeth in the upper arch, so the aesthetic appearance achieved by Mrs K was also poor.
25. The dental records for 31 July 2023 state ‘Patient not happy with length of teeth UL12, claims they are slightly shorter than her natural teeth’. The records confirmed Mrs K raised her concerns about her denture during her appointment. This was acknowledged by her treating associate dentist at the time as the records state Mrs K was ‘informed this was a temporary denture and she will need new ones made in three months once the extraction sockets are fully healed.’
26. We are satisfied the temporary denture provided to Mrs K did not meet the Guidelines in Prosthetic Dentistry. The denture did not meet functional requirements and was not aesthetically acceptable. We are satisfied we have seen failings in the standard of temporary denture provided to Mrs K.
27. We have considered the impact on Mrs K of being fitted with a temporary denture.
28. Mrs K told us her temporary denture made her feel embarrassed, and she lost confidence and stopped smiling at people. Mrs K told us her son was getting married in October 2023 and she was worried about the appearance of her teeth and really wanted the treatment completed before this date. We have seen evidence to suggest the aesthetic appearance of Mrs K’s temporary denture was poor. Therefore, we can understand how Mrs K’s confidence was affected by the cosmetic appearance of her temporary denture.
29. Mrs K also told us her temporary denture was not fit for purpose as she struggled to eat with it and it caused a slight lisp. Our dental adviser told us Mrs K’s temporary denture did not restore function. They advised any significant discrepancy between the way dentures fit against each other or the natural teeth, can reduce chewing function and in our adviser’s view Mrs K’s ability to eat would have most likely been affected. This means any difference in the grinding or biting surface of Mrs K’s dentures which were of different length to her natural teeth would have made eating difficult. We are satisfied Mrs K had difficulty eating with her temporary denture and the denture caused her discomfort.
30. Mrs K was fitted with the temporary denture on 31 July 2023. Mrs K had no alternative but to use the temporary denture until she sought private dental treatment in February 2024. We consider the Practice is responsible for the distress Mrs K experienced from 31 July 2023 when she was fitted with the denture until two months later when she was barred from the Practice and advised of this decision on 5 October 2023.
Issue 2 – Cancelled appointments
31. Mrs K says after her appointment on 31 July 2023, the plan was for her to attend two further appointments on 14 August and 28 September 2023. However these were cancelled because her dentist was off ill/absent and no cover was provided. Mrs K says this meant her course of NHS Band 3 treatment, for her bottom teeth to be extracted and for her lower temporary denture to be fitted, could not be completed. We have considered the evidence in relation to Mrs K’s attendance at the Practice on these dates in turn.
14 August 2023 appointment
32. The Practice accepts Mrs K had an appointment booked for 14 August, but it is unsure whether any work was carried out on this date. Therefore, we first looked to see if Mrs K attended the Practice on 14 August 2023.
33. The Practice’s appointment log for Mrs K confirms she had an appointment booked for 14 August 2023 but there are no clinical entries showing she received treatment. We have seen no evidence the Practice cancelled this appointment in advance. The appointment log is ticked suggesting Mrs K did attend for her appointment. A copy of Mrs K’s NHS treatment plan also appears to have been signed by her on 14 August 2023. On the balance of probabilities, we have concluded Mrs K likely attended the Practice on this date.
34. We next considered if Mrs K actually received dental treatment on 14 August. We can see, and the Practice acknowledges, there are no clinical entries in Mrs K’s dental records on this date although our dental adviser confirmed her records show an invoice was generated. The Practice told us Mrs K’s dentist failed to show up for work for several months but has not specified the date she last undertook clinical work at the Practice. Mrs K’s associate dentist told us she believes she formally left the Practice around this time and did not return due to sick leave.
35. In the absence of any clinical dental records, we have carefully considered if Mrs K was treated on 14 August. We are satisfied on the balance of probabilities Mrs K did not receive dental treatment that day. Our dental adviser reviewed Mrs K’s records and found no evidence of any treatment having been provided.
36. Having concluded Mrs K did not receive further treatment on 14 August 2023 we next considered whether Mrs K received notice her appointment was cancelled beforehand. During our investigation we asked the Practice for copies of all communications, whether by email, text, letter, or telephone, between the Practice and Mrs K in relation to any appointments made or cancelled for her by either party between July and October 2023. The Practice has not provided this information to us.
37. We have received no evidence from the Practice or from Mrs K to indicate the Practice told her the appointment was cancelled in advance. We have therefore concluded Mrs K’s appointment was effectively cancelled without prior notice as her dentist was not present, and we have seen no evidence she was seen by anyone else at the Practice.
38. The General Dental Council Standards say dental professionals should communicate effectively with patients and put patients’ interests first.
39. We have considered if the Practice was in a position to give Mrs K reasonable notice her dentist was not available beforehand. We have accepted Mrs K’s associate dentist likely left the Practice on or around 14 August and did not return due to ill health. We have seen no evidence the Practice had prior knowledge Mrs K’s dentist would not be available on 14 August. We accept the Practice may not have been aware she was going to be absent from work on that date given she left the Practice around this time.
40. On this basis, we are not critical the Practice did not tell Mrs K beforehand her appointment was cancelled or arrange for her to be seen by another dentist that day. We appreciate the high level of demand on NHS dentists and recognise the Practice may not have had a dental appointment to offer Mrs K at short notice. We would, however, have expected the Practice to make another appointment for her to be seen at the Practice to complete her NHS treatment. In this respect, we note Mrs K had a further dental appointment booked for 28 September 2023 and have considered Mrs K’s complaint about this appointment below.
28 September 2023 appointment
41. Mrs K says she attended the Practice again on 28 September 2023 at approximately 9.05am for a 9.30am dental appointment. Mrs K says when she arrived, the receptionist told her the dentist was not there, and her appointment was cancelled again. Mrs K says the receptionist told her they had tried ringing her that morning, but she had not received any missed calls or messages on her phone. She queried why she had not been given advanced notice it was cancelled and felt the Practice must have known when she arrived for her appointment the dentist was not there. She was told the dentist was currently on the phone ringing in sick.
42. Mrs K says she asked to see another dentist but nobody was available. She complained about the situation to the receptionist and asked to see the Practice Manager who was not available although the Practice Owner was present. Mrs K acknowledges she became frustrated and annoyed. She says she voiced her concerns but left on the understanding the Practice would try and arrange another appointment for her.
43. The Practice says when Mrs K was told her dentist was not available, she became abusive and aggressive to staff and the decision was made she would not be seen again as she had breached the Practice’s Zero-Tolerance policy. At this point, we are looking at whether the Practice acted appropriately in relation to the cancellation of Mrs K’s appointment. We have considered if the Practice was entitled to remove Mrs K from the Practice separately below.
44. We are satisfied Mrs K had an appointment booked for 28 September 2023. This is shown in the appointment log. Both Mrs K and the Practice accept her dentist was absent, and Mrs K was not seen by another dentist that day. We have not seen any evidence from either Mrs K or the Practice she was telephoned on the morning of the appointment or otherwise told in advance her appointment was cancelled.
45. We have considered if the Practice was able to cancel Mrs K’s appointment in advance. Mrs K says she was told her dentist was on the phone ringing in sick when she complained at the reception desk. The Practice told us Mrs K’s dentist had a fixed two-year minimum contract. It says she had not left the Practice but ‘failed to show up to work for several months. She has failed to report in sick and failed to provide locum cover.’ The Practice could not tell us when the associate dentist’s period of absence began. Mrs K’s associate dentist has told us, and we have already accepted in the absence of any contrary evidence, her last formal day of work at the Practice was likely to be on or around 14 August 2023. Mrs K’s associate dentist also advised us in July 2025 she did not call in sick on 28 September 2023.
46. We asked the Practice when it last booked appointments for this associate dentist. If they had left without notice this could indicate when the Practice became aware they were no longer available for clinical bookings. The Practice told us the associate dentist’s appointment book has been removed from the Practice appointment book and this was standard practice. It said otherwise there would be no space for new dentists. We are therefore unable to confirm when the Practice stopped booking in appointments for patients with this dentist.
47. The General Dental Council Standards say dental professionals should communicate effectively with patients and put patients’ interests first.
48. There were over six weeks between Mrs K’s appointment on 14 August 2023 and her second appointment on 28 September. Mrs K’s dentist left the Practice on around 14 August. On balance, we are satisfied the Practice had reasonable grounds to conclude Mrs K’s dentist would not be in clinic on 28 September. It should have taken steps to notify Mrs K accordingly. We see an entry in Mrs K’s dental records from 29 August 2023 which says ‘called to move – no message left’. We have concluded this message likely related to Mrs K’s next appointment on 28 September and note no further attempts to notify her of any change to her appointment date were logged.
49. The Practice has given us no information to suggest Mrs K’s associate dentist’s period of sickness/absence was under regular review during this six-week period or that the position was subject to change at short notice. The Practice told us the associate dentist ‘had simply not returned to work’ and her ‘current status was AWOL’. We are satisfied the Practice did not take reasonable steps to notify Mrs K her appointment on 28 September 2023 was cancelled in advance. This is not in line with the General Dental Council Standards in communicating effectively and putting the patients’ interests first. We have therefore found a failing in relation to this issue.
50. We next considered the impact on Mrs K of this cancelled appointment on 28 September 2023. She told us she was frustrated and annoyed to learn her appointment was cancelled that day. This is supported by the entry made in her dental records at that time. Mrs K explained it took approximately 30 minutes by car from home to reach the Practice and she was disappointed to learn on arrival she would again not be seen.
51. Mrs K told us she was keen to complete her treatment as her son was getting married the following month. These events likely added to her eagerness to have her dental treatment completed and frustration when she discovered her appointment had been cancelled. Although we make no criticism of the Practice for not cancelling her 14 August appointment in advice, we appreciate having had one appointment cancelled, Mrs K was distressed and disappointment to arrive on 28 September and learn this second appointment had also been cancelled.
52. We have considered whether the Practice should have taken steps to arrange for Mrs K to be seen by another dentist. The Practice told us this was an unexpected issue, and it could not have known that the associate dentist would not return, so it had not arranged cover for their patients. It further stated had Mrs K not been rude or aggressive, and if her dentist had not returned, another dentist at the Practice would have seen her for a full examination and then completed a treatment plan. Provided the treatment fell within the same band of treatment there would be no additional costs of the patient to see another dentist.
53. On this basis, we consider the reason Mrs K was not seen by another dentist was due to the fact she was barred from the Practice, which we have addressed separately below. However, we do consider Mrs K experienced some distress from the Practice’s failure to cancel her appointment beforehand and consider the Practice could have taken steps to alleviate this by notifying her in advance of the cancellation.
Issue 3- Mrs K barred from the Practice
54. Mrs K complains when she attended the Practice on 28 September 2023 she was told she had been ‘abusive and rude’ in raising her complaint. She says she was unfairly barred from attending the Practice. Mrs K said she was frustrated and annoyed her appointment was again cancelled but she was not ‘violent, threatening, or aggressive to staff’. She says she left with the understanding the Practice were going to try and arrange another appointment for her. Mrs K says the Practice’s failure to complete her treatment and the decision to remove her from its patient list was unfair and distressing. She has subsequently moved to a new practice and paid privately to complete her treatment.
55. The Practice said in its email of 5 October 2023 Mrs K was rude and aggressive to staff when she was told her appointment had been cancelled on 28 September 2023. As the Practice had a Zero-Tolerance policy for rude or aggressive behaviour, it decided Mrs K would not be seen again.
56. Mrs K attended the Practice on 28 September 2023 and was told her appointment was cancelled. An entry in Mrs K’s dental records entered at 9.20am says ‘patient was rude and aggressive to our reception team today. Said this is ‘a rubbish and crap dentist’. As patient was rude and aggressive she won’t be seen again.’
57. We have carefully considered whether the Practice acted appropriately in barring Mrs K from the Practice. We started by considering whether Mrs K’s Band 3 course of NHS treatment was complete when this decision was taken. This is relevant because under the Practice’s GDS contract with the ICB the Practice must use its best endeavours to ensure an NHS treatment plan is completed and can only terminate a course of NHS treatment (i.e. which has not been completed) on specific grounds under its GDS contract.
58. The Practice told us Mrs K’s Band 3 NHS treatment plan has a completion date of 14 August 2023 which suggests her treatment was completed that day. We asked our dental adviser to review Mrs K’s records and advise whether she was still on her NHS Band 3 treatment plan when she attended on 28 September, or if it had been completed on 14 August 2023 as indicated by the Practice.
59. Our dental adviser told us Mrs K’s dental records showed on 14 August 2023 she was invoiced for extractions of the LR2 to LL2 and provision of a lower partial denture covering the LR6, LR7, LL6, LL7 and LR2 to LL2. These numbers and letters refer to the position of each of Mrs K’s teeth. Our dental adviser also reviewed her clinical notes from her new Practice (Practice B) where Mrs K had private treatment in February 2024. These records showed when she attended that Practice, she had extractions of LL1, LL2, LL4, LL5, LL7, LR1, LR2, LR4 and an upper and lower immediate denture fitted.
60. Our dental adviser told us as teeth were still present when she was assessed privately at Practice B several months later in February 2024, this demonstrated the extractions had not been undertaken as agreed with her original Practice and detailed within her Band 3 NHS treatment plan.
61. On this basis, we are satisfied when Mrs K attended the Practice on 28 September 2023 her NHS Band 3 treatment plan had not been completed. This is also supported by comments we received in July 2025 from Mrs K’s associate dentist who told us she left Mrs K’s dental treatment plan open so it could be completed by another dentist.
62.The Practice’s GDS contract sets out when the Practice can terminate a course of treatment. Under clause 33 the Contractor (Practice) may terminate where the patient has been violent or behaved in a way which threatened a person’s safety, and the incident has been reported to the police. Under clause 38 the Contractor (Practice) may terminate when a patient refuses to pay NHS charges prior to the commencement of treatment.
63.Finally, under Clause 39 where ‘in the reasonable opinion of the Contractor’ (the Practice) there has been an ‘irrevocable breakdown in the relationship between patient and that Contractor’ and notice of such a breakdown has been given to the patient by the Contractor, the Contractor may notify the Primary Care Trust (PCT) that it will no longer provide services to that patient under the contract. This makes clear the decision to no longer provide services to a patient is based on the Practice’s reasonable assessment of the situation.
64.We are satisfied clauses 37 and 38 do not apply here. The Practice confirmed it did not report Mrs K’s behaviour to the police and we are satisfied Mrs K paid in full for Band 3 NHS treatment at the outset. As such we looked to see if it was reasonable for the Practice to conclude there had been a breakdown in relationship with Mrs K which justified barring her from the Practice.
65.The Practice says Mrs K’s behaviour breached its Zero-Tolerance policy and because of this it would not see her again. The Zero-Tolerance policy says ‘we will not tolerate any violence, physical aggression or verbal abuse towards our staff by anyone. This includes the use of swear words or any other derogatory behaviour. This applies to in person, on the phone, via email, social media or any other interaction. Our Zero-Tolerance policy means if this occurs you will not be seen again at our practice.’
66.The Practice is not entitled to set a lower threshold in its Zero-Tolerance policy than is set out in its GDS contract for NHS patients. That said, we agree the Practice is entitled to protect its staff from any form of abusive behaviour and promote a culture of respect and tolerance from patients.
67.The decision to bar Mrs K from the Practice was taken by the Practice Owner who was present in the reception area at the time of these events. The entry in Mrs K’s dental records made at 9.20 am says she had remarked ‘this is a rubbish and crap dentist’. In the Practice Owner’s view this contravened the Practice’s Zero-Tolerance policy. Whilst these comments are not objectively aggressive, we cannot say the Practice Owner’s assessment of Mrs K’s behaviour, tone, and manner was unreasonable given he was present and witnessed her behaviour at the time.
68.In reaching this conclusion, we have also had regard to an email Mrs K sent to the Practice afterwards giving her explanation of what had happened. She said ‘I had been building myself up for the extractions, I know it was not reception’s fault…’ She also said in her email she had spoken to the Practice Manager the next day and asked her to relay her apologies to the member of staff concerned.
69.We appreciate Mrs K was frustrated she had travelled to the Practice and her appointment was again cancelled and we understand she was keen to have the treatment completed. That said, we have decided we cannot say the Practice was being unreasonable in the conclusion it reached.
70.Mrs K was not informed at the time she had been barred from the Practice. Mrs K complained to the Practice on 29 September 2023 and received a response from the Practice Owner explaining as her complaint was clinical it had been forwarded to her associate dentist to respond.
71.Mrs K subsequently emailed the Practice Owner again on 4 October 2023 to say she had received a phone call from the Practice Manager explaining they did not wish her to return to finish her treatment as her attitude had been abusive. On 5 October 2023 Mrs K sent a further email to the Practice about the incident on 28 September 2023. Mrs K received written confirmation from the Practice Owner by email later that day stating as they have a Zero-Tolerance policy for any rude or aggressive behaviour, she would not be seen again.
72.We are satisfied based on this exchange Mrs K was effectively given notice of the breakdown in the relationship by the Practice as required under its GDS contract. We are satisfied Mrs K received notice of the Practice’s decision within a reasonable time (a week) following the incident. Although the Practice did not use this specific phrase ‘breakdown in relationship’ the Practice’s intent and the implications for Mrs K were clear.
73.The Practice did inform Mrs K it was not willing to see her again allowing her to register with an alternative dental practice. It was also clear the decision was based on the Practice’s assessment of her actions on 28 September 2023 which we consider equated to a breakdown in relationship. We have therefore not found any failings by the Practice in relation to this issue.